Ventricular Septal Defect (VSD)

Ventricular septal defect, called VSD, is an opening between the lower chambers of the heart, the right ventricle and left ventricle (see diagram).

heart

What is a Ventricular Septal Defect?
How does a VSD affect the body?
What are the treatment options for a VSD?
How is surgery different from an implant?
What are the benefits to having an implant?

What is a Ventricular Septal Defect?

The septum is a wall that separates the heart's left and right sides. Septal defects are sometimes called a "hole" in the heart. A defect between the heart's two lower chambers (the ventricles) is called a ventricular septal defect (VSD).

open heart

When there is a large opening between the ventricles, a large amount of oxygen-rich (red) blood from the heart's left side is forced through the defect into the right side. Then it's pumped back to the lungs, even though it's already been filtered and refreshed with oxygen. This is inefficient, because oxygenated blood displaces blood that needs oxygen. This means the heart, which must pump more blood, may enlarge from the added work. High blood pressure may occur in the lungs' blood vessels because more blood is there. Over time, this increased pulmonary hypertension may permanently damage the blood vessel walls.

If the opening between the ventricles is small, it may not strain the heart. In that case, the only abnormal finding is a loud murmur.

How does a VSD affect the body?

A ventricular septal defect is often detected during a routine exam due to the presence of a heart murmur. VSD's can range in size from quite small to quite large. People with small defects generally have no symptoms, and often are not treated.

Some people will have their uncomplicated ventricular septal defects repaired early in life, restoring normal blood flow, and will not have any long-term problems.

In patients with larger VSD's, or multiple VSD's, symptoms can be severe. For these reasons, the current standard of care is to close larger ventricular septal defects which allows the right heart size and blood flow into the lungs to return to normal.

An untreated VSD may cause the heart to pump inefficiently which in time may cause enlargement of the muscle, fluid retention and possibly pulmonary hypertension. Occasionally, VSD's will occur in adults as a complication from a heart attack.

What are the treatment options for a VSD?

Closing small ventricular septal defects may not be required. They may close on their own in childhood or adolescence; however, if the opening is large, even in patients with few symptoms, closing the defect in the first two years of life may be recommended to prevent serious problems later. Patients who have a large VSD due to an MI or other cause may also be advised to have their VSD closed. The defect may be closed percutaneously (catheter procedure) with an implanted device, during open heart surgery using a surgical patch or sewn closed. Over time the normal heart lining tissue covers the area, so it becomes a permanent part of the heart.

How is surgery different from an implant?

Open heart surgery for VSD closure is considered a high risk, major, invasive procedure which generally follows this sequence:

The patient is anesthetized using a deep general anesthesia.
The breastbone is cut lengthwise about 5-8 inches.
The chest cavity is cut open and the heart exposed.
The heart is stopped and the patient is put on a heart lung machine.
The heart is cut open and a cloth patch is sewn over the defect, or the defect edges are pulled and sewn together.
The heart is closed, and the patient's heart restarted. The heart lung machine is removed.
The chest cavity is sewn closed.
The breast bone is sutured together using wire sutures.
The patient is transferred to ICU and very closely monitored, usually with the aid of a breathing machine (respirator).
After 7-14 days in the hospital, the patient is discharged.
After 6-8 weeks, the patient returns to normal activity.

Surgery for VSD has been performed for many years with good results, although it is considered a high-risk operation. Deaths and complications, while infrequent, do occur. Despite the best efforts, sometimes the sutures used to close the defect will break resulting in residual leaks.

Open heart surgery carries with it some significant complications. Those include:

Death
Anesthesia reaction
Endocarditis
Bleeding requiring transfusions
Transfusion reactions
Wound infection
Myocarditis
Stroke & TIA
Arrhythmias requiring medications or pacemakers
Pleural & pericardial effusions

While the surgical history in congenital disease is good, the frequency of complications increases with the severity of the heart disease. In addition, the surgery does not always result in total closure of the defect.

If you are considering surgery, ask your surgeon or cardiologist for specific information about the results of the surgery at your hospital. Generally, surgery requires 7-14 days in the hospital in uncomplicated cases, and 6-8 weeks of recovery at home prior to returning to full, normal activity. Pain can be significant, and pain management is routinely provided during the post operative and recovery phase.

What are the benefits to having an implant?

An implant can be placed in the heart closing the VSD using a catheter. This procedure is called Transcatheter Defect Closure. A transcatheter closure procedure is less invasive, avoids the need for open heart surgery, and therefore poses fewer risks than open heart surgery.

Transcatheter closure is performed in the Cardiac Catheterization Laboratory by an Interventional Cardiologist trained in transcatheter closure techniques. Typically, this doctor will work with a team of two other doctors: An anesthesiologist and a specialist in Echocardiography. The doctor will gain access to the heart by accessing a major vein in the groin, called the fuoral vein, or by gaining access to the internal jugular vein, which is one of the main veins in the neck. In some cases, both the right and left fuoral vein may be used.

Human Body

Access is gained by a needle puncture. The area where the puncture is made is thoroughly cleaned and anesthetized (numbed) using a local anesthetic. Various catheters will be advanced from this location into the heart. Moving pictures, called angiograms, will be taken to better visualize the heart and the defect. The physician may use a special ultrasound device, called Transesophageal Echocardiography (TEE) or Intracardiac Echocardiography (ICE) during the procedure. Both are more precise methods of viewing the heart and the defect using sound waves. The appropriate size CardioSEAL^® implant is prepared for placement through a special catheter. Then the catheter is advanced to the site of the defect. The physician deploys the implant so that half of it sits on each side of the defect. The defect is gently sandwiched between the two sides of the implant. The implant is then released from the catheter. The catheter is removed and the procedure is completed.

The risks are similar to those associated with other heart catheterization procedures:

dislodgement
incomplete sealing of the defect
abnormal heart rhythms
bruising at the access site
changes in blood pressure
air embolus
hemolysis
apnea
headache/migraine
infection including endocarditis
perforation of vessel or myocardium
thromboubolus
stroke or TIA

Typically, after the procedure:

Bed rest for a period of time, usually 4 – 8 hours (this allows the implant to firmly stabilize). The specific circumstances of your procedure may lengthen or shorten this period of time. Your physician will advise you about this.
Restriction from heavy lifting or other physical activities for a period of time, usually 5-7 days. The specific circumstances of your procedure may lengthen or shorten this period of time. Your physician will advise you about this.
Taking blood thinning products, such as Aspirin, every day, for a period of time, usually six months (perhaps several months longer). The specific circumstances of your procedure may lengthen or shorten this period of time. Your physician will advise you about this.
Taking antibiotics to prevent infection (this may be required when going to the dentist or having a minor surgical procedure) for at least six months following the procedure. The specific circumstances of your procedure may lengthen or shorten this period of time. Your physician will advise you about this.
Follow the doctor’s instructions precisely.
Call the doctor if there are any questions.

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Heart Repair

Ventricular Septal Defect (VSD)

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